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Background: Methamphetamine (MA) use is associated with increased HIV risk behaviors among men who have sex with men (MSM) and poor HIV treatment outcomes in MSM living with HIV. The Getting Off app, a smartphone-based cognitive behavioral therapy intervention for MSM, has been shown to reduce MA use and some sexual risk behaviors, but it is unknown whether certain psychosocial factors were associated with augmented or attenuated treatment response.

Methods: The present study is a longitudinal secondary data analysis of participants in the Getting Off app randomized controlled trial. Psychosocial factors of interest included repeated measures of self-reported depressive symptoms, housing instability, and income over 9 months. Outcomes included repeated measures of number of days of MA use in the past 30 days, number of days of MA injection in the past 30 days, and CAI, CAI while using MA, all evaluated over 9 months. Mixed effects negative binomial regressions and mixed effects logistic regressions were used to evaluate associations between psychosocial factors and these outcomes.

Results: Participants who self-reported depressive symptoms had 47% greater number days of MA use in the past 30 days (IRR = 1.47, 95% CI [1.18, 1.83], p < 0.001) and 3.20-fold greater odds of CAI while using MA (OR = 3.20, 95% CI [1.67, 6.13], p < 0.001) compared to those reporting no depressive symptoms. Participants with depressive symptoms had greater odds of reporting any CAI at baseline (OR = 3.65, 95% [1.95, 6.82], p < 0.001). However, this group also had a 14% greater monthly reduction in odds of CAI (OR = 0.86, 95% CI [0.77, 0.96], p = 0.008) compared to those reporting no depressive symptoms. Having an annual income greater than or equal to $15,000 was associated with a 35% decrease (IRR = 0.65, 95% CI [0.45, 0.93], p = 0.018) in number of days of MA use in the past 30 days and a 64% decrease (IRR = 0.36, 95% CI [0.14, 0.91], p = 0.032) in number of days of MA injection in the past 30 days, but greater odds of any CAI (OR = 3.37, 95% CI [1.48, 7.69], p = 0.004) and CAI while using MA (OR = 2.90, 95% CI [1.24, 6.80], p = 0.014). Homelessness was not associated with number of days of MA use in the past 30 days, number of days injecting MA in the past 30 days, or CAI while using MA. Time was associated with reductions in the number of days of MA use, the number of days injecting MA, and with engaging in CAI while using MA.

Conclusion: Depressive symptoms were associated with greater MA use and CAI, while income showed mixed associations, highlighting the added importance of addressing of other contextual factors in smartphone-based behavioral interventions.